How Ontario plans to 'transform' health care

The Ontario government plans to offer more surgeries in stand-alone clinics, tie funding to individual patients not hospitals and provide more after-hours doctor visits as part of a major health-care overhaul, the province's health minister said on Monday

Four key changes proposed on Monday by Deb Matthews, the Ontario health minister: • Surgery clinics: Many of the procedures now performed in hospital – the most expensive, infection-prone segment of the health-care system – will be farmed out to stand-alone clinics, like one in Toronto that now performs cataract operations with assembly-line efficiency. Ms. Matthews would not say which procedures might be considered for this shift, however; • A doctor when you need one: The minister promised that more family doctors would be available after hours and would offer appointments the same day or next day. It was unclear exactly how the province can achieve that, but she said physicians could schedule appointments more efficiently. • Funding the patient, not hospitals: Hospitals now receive most of their budget in the form of annual blocks of money, arguably giving them little incentive to enhance service. Ms. Matthews said the province will reduce significantly those chunks of funding, and pay out more of the cash as fees for each patient that a hospital or clinic treats. • Less hospital, more home care: Chronically ill but stable patients stuck in pricey, acute-care hospital beds are a well-documented problem. The minister said the province will try to solve it by funnelling as much money as possible into home-care services – not nursing homes – so the old and infirm can stay in their houses and apartments longer.

The Ontario government plans to offer more surgeries in stand-alone clinics, tie funding to individual patients not hospitals and provide more after-hours doctor visits as part of a major health-care overhaul, the province’s health minister said on Monday.

The changes are needed to cope with an aging population and massive deficit, said Deb Matthews.

“We can’t keep spending our health dollars the way we used to,” she said. “If we don’t change, we simply won’t be able to guarantee sustainable universal public health care.”

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Her announcement of the new plan to a Toronto Board of Trade luncheon comes after the federal government revealed that it intended to scale back yearly increases in health funding after 2017 to approximately the rate of economic growth, a proposal that has been decried by most premiers.

In Ontario, health care already consumes about 38% – or $47-billion – of the province’s budget, which is $16-billion in the red.

The political sensitivity of the file shone through last week as the Ontario health minister rapidly backtracked from a hint that the government may end coverage for Caesarean sections that are not medically necessary.

The federal plan as announced by Jim Flaherty, the finance minister, is to continue increasing federal health transfers at a rate of 6% a year until 2017, then limit hikes to a formula that combines GDP and inflation, but never falls below 3% annually.

The provinces have criticized the federal move as insufficient to meet the medical demands of an aging population, but at a meeting last week said they would set up a working group to develop innovations in health care over the next six months.

Last week, Ms. Matthews suggested that the province would only pay for those services that are shown to provide a real benefit.

“If there is not evidence to support a procedure or a test, we don’t want to pay for it,” Ms. Matthews told reporters.

Even at a time when health care is increasingly dedicating itself to “evidence-based medicine,” however, determining what works and what does not is sometimes less than straightforward.

The minister said adding new childhood vaccines is a proven boon to health; on the other hand, she noted, the province removed funding for universal testing of vitamin-D levels amid evidence that the tests were often not medically warranted.

Don Drummond, the ex-banker commissioned by Dalton McGuinty, the Ontario premier, to come up with a plan for streamlining government services and spending, has noted that the rate of Caesarean sections in Ontario is much higher than the national average.

Asked about that comment last week, Ms. Matthews refused to say if the province would de-list C-sections when they are not medically necessary, but said more work is needed “to make sure everyone is practicing the highest quality medicine.”

When that was reported as a hint that some Caesarean sections would be cut off from coverage, the minister came out the next day to firmly insist no such plans were in the works.

It is unclear how the plans Ms. Matthews announced Monday will mesh with the recommendations in Mr. Drummond’s report, which is in the government’s hands and expected to be released soon.

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